Endoscopes are a prime element used in order to achieve Minimally Invasive Surgery (MIS). However, it has been difficult to achieve dexterity and precision of instrument control within the confines of a limited operating space, further compounded by the need to operate from a 2D video image. The application of robotic technology has the potential to contribute significantly to the advancement of endoscopic spine surgery.
As described in the section on “Robotics: An Approach to Minimally Invasive Spine Surgery”, http://bme240.eng.uci.edu/students/10s/sgupta1/RobotSpineSurgery.html in the section entitled “Application of Robotics to Endoscopic Spine Surgery” in the course on Introduction to Clinical Medicine at the University of California at Irvine, there is described the use of a surgical robot with haptic control for this purpose, having several distinct and compelling advantages, which suggests that this particular technology is capable of significantly enhancing current operative technique. Unlike conventional instrumentation which requires manipulation in reverse, the proportional movement of the robotic device allows the instruments to follow the movement of the surgeon's hands directly. The intuitive control of the instruments is particularly advantageous for the novice endoscopist. In addition to mimicking the surgeon's movements in an intuitive manner, the robotic instruments offer six degrees of freedom plus grip, two more than conventional instruments. This technology permits a large range of motion and rotation that follows the natural range of articulation of the human wrist and may be particularly helpful when working space is limited. The electronic control system is capable of filtering out hand tremors as well as motion scaling, whereby gross hand movements at the surgeon's console may be translated to much finer movement of the instrument tips at the operative site. The 3D vision system adds a measure of safety and surgical control beyond what is available with the traditional endoscope. The 3D display improves depth perception, and the ability to magnify images by a factor of 10 allows extremely sensitive and accurate surgical manipulation. The alignment of the visual axis with the surgeon's hands in the console further enhances hand-eye coordination to a degree uncommon in traditional endoscopic surgery.
All of these features are related to the advantages of robotic endoscopy in providing haptic and visual support to the surgeon once the procedure is in progress. However, another area so far untackled is the need to provide accurate access for the endoscope to the operation site, in order to reduce the trauma of the procedure. If an incision for an endoscopic procedure is made in the patient's soft tissue in the incorrect position or at an incorrect angle, it is difficult to make an intraoperative correction to reach the required operating site without either significantly enlarging the extent of the incision, or withdrawing and making a second incision to gain more accurate access to the operating site. This problem is particularly acute for operations performed on the spine, such as percutaneous discectomy. In this procedure, an annular tear, bulging disc, or herniated disc which is compressing a nerve may be accessed using an endoscopic technique, and a laser or knife used to correct the tear or remove the bulge. After the damaged portion of the disc has been removed, the laser vaporizes the surrounding area, and can shrink and remodel the remaining disc. Because of the closeness of the operating site and its access paths to major and critical nerve structures, high positional accuracy of the endoscope insertion path is required.
There therefore exists a need for a robotic endoscopic apparatus and procedure which will provide adequate solutions to these problems, and especially to reduce the level of surgeon skill required to maintain minimally invasive conditions.
The disclosures of each of the publications mentioned in this section and in other sections of the specification, are hereby incorporated by reference, each in its entirety.